on the Legitimacy of ‘Free’ Health Care

Disclaimer: Opinions reflected here are my own, and not representative of any other person or entity. This post isn’t even about a specific country. It’s entirely hypothetical. Any resemblance to actual places or policies is completely coincidental and should be ignored.

No person in need should be refused health care because they are unable to afford it.

If someone is sick they should get be able to access the treatment and investigations they need without going bankrupt. This is what the World Health Organization considers ‘Health for All‘.

But health systems need to be sustainable. Governments shouldn’t promise health care gratis and then serve up a substandard product. Free service with unacceptable wait times, drug shortages and costly basic interventions is impractical and unfair to the population receiving it. It’s free health care in name only, a political tactic, and frankly demeaning to the patients who must navigate these inaccessible territories.

Being able to get medical help without having to pay through the nose is great! I see a doctor at my local clinic for free, get a prescription which I fill at the nearest government pharmacy for free. If I need blood work, an x-ray or ultrasound, those are all free too. If I need to be hospitalised, I don’t need to worry about a bill, and I can rest assured that the hospital has all the resources required to treat me according to international standards.

But what if there are not enough doctors in the clinic, or not enough space in the hospital? What if there isn’t enough medicine in the pharmacy, what if the machines for blood testing or x-ray or ultrasound aren’t working? What if the hospital is overwhelmed by demand and its resources are inadequate for a population this size? What happens then?

I don’t have the answers but I’m sure the solution is more complicated than just throwing more money at the problem. Sustainability and capacity building are nuanced and necessary concepts that demand to be addressed. Failing to take them into consideration results in a quagmire of dissatisfaction and deteriorating quality.

If high quality, patient-centered health for all is the goal, then the steps to get there must reflect this realignment of values. Any health system that decides to serve users at no charge must remember that it exists to serve, and not to inconvenience or ignore its customers.

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2 thoughts on “on the Legitimacy of ‘Free’ Health Care”

My country theoretically has free health care for all – well, those who can’t afford it. THEORETICALLY one gets billed according to your means, so my bill would be higher than someone earning minimum wage.
The first problem with that is that the billing departments are rubbish and people almost never actually get a bill to pay.

The second problem is that our public health system is so poorly managed that the service is constantly at risk of being substandard. Even if the overworked and underpaid doctor manages to deliver pristine service, chances are good that their patient waited six hours to see them, and that they won’t be able to get the best medicine for their condition.

So our private sector flourishes, but is exorbitantly priced. My monthly antidepressants cost always as much as my monthly groceries. That’s AFTER half of it is covered on my “chronic condition” benefit. I wish I could use that money to save for retirement.

I think chronic conditions should be free, and emergency conditions. I think expecting those with the means to pay a reasonable portion is maybe not unfair.

But coming to the clinic for minor abdominal pain, or a mild fever, or anything that could be managed over the counter, should have a nominal fee.

I’m sure there are problems with my suggestion, but I definitely thing something needs to change.

There’s so many similarities between our systems! This comment could be a whole blog post. Our system does cover some chronic conditions so that the patient only pays a small fee, but like you said the medication is often unavailable.